Cancer signs could be spotted years before symptoms, says new research institute | Hacker News Reader

Cancer signs could be spotted years before symptoms, says new research institute

theguardian.com

131 pointsBrajeshwar68 comments

Cells mutate and become cancerous all the time, but the immune system is usually able to recognize this and shut down the errant cells before it becomes a problem. It's only when the cancer gets lucky with the right site of mutations that it's able to evade the immune system and grow unchecked.

Early diagnosis would obviously be a good thing if we can reliably tell which cancers will become a problem. My concern is that most patients may have a hard time understanding this distinction, and we may end up with people demanding screenings and treatments that they'd be better off without.

In case anyone thinks these fears are unfounded, keep in mind this is already a problem with thyroid cancer. Thyroid cancer is very common and frequently harmless, but increased screening is leading to more people being treated for it, and it's unclear whether this is a net benefit.

But that’s not what the article says? From what I understood they were able to identify only those that end up developing to cancerous tumors. Not the ones that you mention?

Not all cancerous tumors are really dangerous or worth treating. For example, prostate cancer is common among elderly men and they often die of something else before the tumor causes serious symptoms.

That's actually no longer recommended. Men are living longer and treating the prostate is almost always recommended now.

> It's only when the cancer gets lucky with the right site of mutations that it's able to evade the immune system and grow unchecked.

What happens if you happen to have some cancer mutations while you're young and healthy - but also super sick and your immune system is busy with other stuff?

Is this part of the reason cancer is more prevalent later in life? The longer you live, the more likely something is going to sneak past, along with decreased effectiveness of the immune system as we age?

Early treatment of cancer is not always better: "Surgery for early prostate cancer may not save lives. Most men just as likely to survive with limited or no treatment" https://medicine.wustl.edu/news/surgery-early-prostate-cance.... I wonder if this is true of other types of cancer.

I think this is unique to prostate cancer.

As it says the average age of men getting it is 67. From experience and from data I had seen, a lot of times, the surgeons simply believe the patient is too old to have any surgery. And when they die -- e.g. family I had -- they note down the cause of death as natural causes. When you are 80-90+, practically everything gets written as natural causes.

Finally, with prostate cancer, from what we know it is not a question if a man will have prostate cancer but if the man will die before prostate cancer becomes serious or appears. That is if we doubled the age of survival to 200 years I think we would expect virtually every male at that age to have gone through prostate cancer.

That may be the case, but the other failure mode for early cancer testing is that you identify disease signals which will not turn out to be meaningful in the long run even without intervention. Iatrogenesis is a big problem with a lot of this stuff: the follow-on treatment for an epithelial precancer hit from your stomach is not harmless.

This is a reason I've read evidence based medicine people use for arguing against routine whole-body imaging.

Yes. I was touching solely the likely unique characteristics of prostate cancer. Maybe I need to clarify, but that is what I got the comment I was replying to indicated.

There was a meta-analysis published in JAMA last year which concluded that screening is unlikely to prolong lifetime for other than colorectal cancers:

https://jamanetwork.com/journals/jamainternalmedicine/articl...

> The findings of this meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by approximately 3 months; lifetime gain for other screening tests appears to be unlikely or uncertain.

I am neither a physician nor qualified to comment on the article itself, but remember reading an MD commenting on it last year saying efficacy of screening was better in the 80s-90s, but with contemporary cancer medicine and improvements in surgery, we can now treat bigger cancers so early screening doesn’t necessarily prolong life expectancy.

I would not take medical advice from myself or that article though. But to your comment, I doubt it’s only prostate cancer where early screening and treatment might not yield any returns

Hmm, I notice that melanoma wasn't addressed in this study; maybe "having a good look at suspicious moles just in case" doesn't count as screening, but early detection of melanoma is considered pretty important for survival.

Yeah, again without really having any education in healthcare, I suppose that if you find a cancer before it spreads then you can operate it out. So makes sense to get suspicious moles or generally any health issues checked

It's sort of a good example of the counterpoint at the same time though: other than melanoma, skin cancer is pretty minor in general (and having it is correlated with increased life expectancy!) so combined with how rare melanoma is, I could imagine that a lot of such screening might not be associated with a net benefit.

"how rare melanoma is"

For a rare disease, I have already met too many people who have/had it. Lifetime risk is about 1:100 for white Europeans, not exactly commonplace, but not that rare either. I definitely don't ignore anything that happens on my skin, that would be a stupid way to die.

Fair, but globally it causes something like 60 thousand deaths per year (out of 55 million or so). That’s nothing to sniff at, but certainly in the realm of something you are very unlikely to die from. For comparison, cardiovascular disease kills about 17 million people per year.

My dad refused treatment for his prostate cancer when he found out there was a high probability he would end up incontinent. He basically just said to my mom and his doctor “I’d rather die.” It’s been 20 years since. The tumor has completely halted its progression. Sometimes things just work out .

If you know the details, care to share them? Like Gleason score? Does he have yearly biopsies or MRIs?

I would tell you if I could, but as you might expect from the type of person who would respond this way my dad hates talking about or dealing with anything medical. I doubt he even remembers these things. He does do a yearly checkup and I’m not sure if that includes a biopsy these days (it definitely has in the past.) I basically have to catch him a day or two after his checkup in order to get any information and even then I just get the minimum amount of information possible.

A doubt - why would someone do "yearly biopsy" when you already know the tumour is cancerous? Does an annual biopsy help in some other way?

This article is from 2017.

This is almost always because of other comorbidities. People tend to get prostate cancer when older and it often (but not always) progresses slowly.. If you have other issues like obesity then you are likely to die from something else first. However, for otherwise healthy people, especially in their 60s or early 70s, it's a good idea to treat it early and aggressively. There are about 35,000 deaths from prostate cancer in the US every year; the leading cancer death after lung cancer.

> Early treatment of cancer is not always better

Sure, nothing is always better. If an intervention is statistically not better, then we will not be doing that kind of thing in the future. Better data will lead to better treatment, as will continued research.

But statistically early treatment will always end up being better. There is no theoretical situation in which having less time to systematically change an outcome will beat having more time.

Also not sure how quickly things progress in this particular case, but the article is from 2017 so that's quite a few years already.

For what it's worth, this isn't new, just a new investment. There are a ton of companies in the cell-free biopsy space for early cancer detections, with the biggest name being Grail. We're more or less in the engineering/process improvement stage of early cancer detection, not the pure research stage.

Early detection of cancer is crucial for successful treatment and improved outcomes. So happy to see those kind of news.

Agreed.

Between all of the technical dissection and interpretation that is sure to ensue here, the human aspect, tempered with not getting hopes up, is that progress like this is invaluable for the many who can't access the best treatment, vs the few who can.

This is really cool.

Maybe as this moves on with early detection, we'll be able to deliver custom moderna cancer vaccines are immunotherapies to kill cancers before they can root.

Having witnessed my mother fight and pass away from cancer rather recently, signs of cancer are definitely obvious in hindsight but they never strike anyone as such at that point in time.

Basically: "Yeah, looking back on it that was cancer wasn't it? God damnit..."

Ditto, except for myself: https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...

One problem is: how often do those signs turn out to be cancer, versus something else?

There are now circulating tumor cancer DNA tests (ctDNA), though they're presently expensive: https://www.natera.com/oncology/signatera-advanced-cancer-de.... If they get cheap enough, they'd be interesting as part of, say, an annual blood panel. Mine were like $5k each, however, so that's not going to happen in the general population in the short term.

I was using the Signatera tests to try to determine whether I should start prophylactic chemotherapy after a total glossectomy. The answer turned out to be "yes," but three days before I began chemo, a CT scan ordered to ascertain whether I could use a jaw-stretcher device showed six to eight new tumors, less than two months after the surgery. So the direction was correct.

...God damn, man.

I'm glad you're still here with us, but I... don't know what to even say.

Thank you for speaking and not being silent when life is hard.

According to an oncologist I spoke with, there are “shedders” and “non-shedders,” i.e. whether a tumor sheds DNA into the bloodstream or not. Apparently I’m a non-shedder :/

I thought the circulating tumor DNA tests were $1k. I know because I was interested in getting them.

Any idea why they're so expensive?

What examples do you have in mind? I ask because both of my in-laws passed from very aggressive cancers, but there really isn't much I can point to as meaningful signs. In hindsight, it did seem like a lot of people in their neighborhood also passed from various cancers, but even then they were all different types and I'm not sure it was statistically significant.

Isn't a sign of a disease called ... a symptom ?

No, A symptom is a manifestation of disease apparent to the patient himself, while a sign is a manifestation of disease that the physician perceives. https://jamanetwork.com/journals/jama/article-abstract/34161....

The term seems to be thrown around to mean either. High blood pressure is a sign of other diseases, and some call it a symptom, but it is a measure rather than something people can perceive. I feel like I can tell my blood pressure is high, but I think I am feeling other sensations that correlation with HBP.

People don’t necessarily use terms correctly, but it’s ‘feels or experiences’ so poor circulation is a symptom even if people are describing cold extremities. Very high or low blood pressure is definitely something people can notice unlike say latent TB which is only going to show up on tests.

A symptom is what you show. A cough is a symptom, detection of a viral protein is evidence of infection.

I lost someone close to me to melanoma that metastasized to the brain. It grew for at least 6 months without symptoms. And when symptoms presented, they weren't immediately evident of a tumor until it had progressed. She was being actively monitored for melanoma at the time - having the ability to detect it earlier would have made all of the difference.

Doctors draw a distinction. A sign is something they can measure (a high body temperature, say). A symptom is something you report experiencing (“my joints ache”)

this is obvious to literally anyone who is in tune with their bodies, it doesn't take science to say so. Chronic inflammation is a great place to start. Because even if you don't have cancer, it's likely you're trending towards diabetes or some other major illness. inflammation is one of the number one markers for "SOMETHING IS AFOOT".

most people are so divorced from being in sync with their physicality, and are so far removed from understanding what normal should feel like, and are often so blunted by prescription medications and other compensatory mechanisms, that it makes "something doesn't feel right" highly impractical sadly.

even now, people here will scoff at this notion while willfully turning a blind eye to their own personal pains/afflictions/signals, even though rates of cancer and other diseases are skyrocketing. And this is because it's all wrapped up and embroiled in a scary cognitive dissonance that most people actively work to maintain, because it sucks and it's kind of scary to put a spotlight on your own mortality.

This is not obvious to literally anyone.

You've never met or heard about a perfectly fit person in the prime of their life getting a stage 4 diagnosis of something or other?

sure have. my cousin is a personal trainer who ran a gym studio from his garage. Was in great external physical shape. And his house reeked of mold. Absolutely insanely smelly. My wife warned him for years because she's sensitive to the odor, and he just completely refused to accept that there was mold in the house or that it was a problem or that there was any smell at all.

he was later found to have stage2 cancer.

just because he looked good, was he ACTUALLY good?

no. sleep apnea. aching joints. a random bout of shingles at the age of 39. the list of "things" goes on, and most people have lists like this that they refuse to examine or consider as building blocks of a potentially encroaching larger issue.

again, because of fear.

The problem is you're treating these like signs of cancer when they aren't. People with mold in their house don't necessarily have cancer, people who get shingles don't necessarily have cancer, aching joints is less than useless as a measure for cancer. You're working backwards, now anything that's incorrect with someone is proof if they ever develop cancer while ignoring everyone who doesn't.

Somewhat tangential question, can someone briefly say how mold is related to cancer?

Also isn't mold somewhat common in American homes?

You could blame it on anything you want because you're not using science. You could say it was radio waves, vaccines, processed foods, or micro plastics. You would never be wrong because the ones who haven't gotten cancer just didn't get enough exposure yet.

Well, I think what the parent comment is trying to say is that we’ve made it socially acceptable to live in an unhealthy way and many of the “obvious” conditions that are precursors to serious disease like obesity, over medication, chronic inflammation, etc are just accepted.

However, we should be making it clear that unhealthy lifestyles result in bad outcomes.

This was all very obvious before we started to muddy the waters with our blank check acceptance of bad choices (fat acceptance, etc).

I don't disagree with the premise we've issued blank checks for unhealthy lifestyles, but I disagree that's what the parent comment was saying.

Asking people to self diagnose inflammation is a lot different than understanding that being overweight is unhealthy.

I don't know why you're getting downvoted. This is 100% correct.

It's an ambiguous rant, that's why it's getting down-voted. No specific message. No sources. No data. Just an empty lecture on "listen to your body!", but no substance to explain how, why, what to do etc.

The core steps to paying attention to yourself:

- notice

- fill in the picture

- use it to inform your decisions

For example, my oral health fluctuates based on what I eat. Too much sugar or sweet carbs, and my gums start feeling itchy and sore. Having that self-awareness helps, because when it starts becoming a problem, I can take corrective action, and fix my mouth before I get a cavity or lose gum tissue.

Now, this is exactly what a dentist would say - brush and avoid sugar. What self-awareness helps with is knowing how much is too much! I'm not flying blind, I know what "good mouth" and "bad mouth" feel like.

Which works fine for something simple like "if I eat too much sugar I get a tummy ache". It's harder to do with something that is hard to detect, like pancreatic cancer, or a symptom that could be caused by a huge number of things, like feeling tired. The first problem is the one that's trying to be solved by the solution in the article.

Yeah, that's a simple example. Pancreatic cancer would be at the other end of the scale:

- it's internal

- nobody really knows what their pancreas is supposed to do anyway

Plus the normal problems with self-analysis:

- distinguishing signal from noise

- going around looking for a problem means overpowering whatever signal there was with conscious attention

Still, I think someone with a stable routine, who has practice teasing out subtle signals, could pick up on something like that. Once you have enough experience with how your body "should" work, any deviation is noticeable.

At best they could determine something was wrong, maybe that they were tired more than they should be, and would have to go to a doctor for answers. I very much doubt anyone could go "Yup, I have pancreatic cancer." It's really hoping that someone could pick up very slight symptoms, and I don't think that they'll always be as apparent as you'd hope. It almost feels like victim blaming to say that if they'd just been more in touch they could have detected the barely detectable. Are there any examples of someone detecting pancreatic cancer early on their own?

Likely because, similar the other thread about obesity, this article is referring to direct evidence of genetic changes rather than observation of ones differentials or symptoms.

Just a guess, I know very little about this subject.

Because they didn't read the article.

although down voted, controversial, not generally provable, and possibly condescending

this perspective shouldn't be discounted

Yeah, very true. Obviously you can't do everything yourself, but a lot of people have gone the other way, and given away responsibility for their health to the professionals and the numbers.

The numbers don't tell the whole story, and the professionals are looking out for themselves as well as taking care of you (at minimum!)

I absolutely agree that people should try to "know their bodies" and develop their intuitions as far as possible. It can make all the difference in terms of spotting a critical illness in time (not always, but sometimes).

However, health/medicine is a field rife with misinformation, rife with questionable ideas about what "intuition" can really tell you, and the dividing line between the true and the confidently incorrect can be hard to pin down.

And what really sets off alarm bells, to me at least, is proposing that it should substitute these intuitions for professional expertise, or should be understood as being at cross-purposes with it. I think the best case for valuing our intutions would come from a place of treating them as complementary to professional expertise.

> it makes "something doesn't feel right" highly impractical sadly.

What kind of doctor would a person go to for something like that?

It would be obvious to you if your esophageal cells started producing TTF3? What would that feel like?

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